Living a Healthy Life with Chronic Pain (14 page)

Our minds have trouble focusing on more than one thing at a time. Therefore, we can lessen the intensity of symptoms by training our minds to focus attention on something other than our bodies and their sensations. This technique, called distraction or attention refocusing, is particularly helpful for people with chronic pain conditions.

Research has shown that when a person focuses on pain, several areas of the brain show more intense pain-related activity than when a person is distracted from the pain. Many studies have found that people who constantly direct their attention to pain and think about it all the time are more likely to expect the worst from their pain problem and to feel helpless about controlling it. Consciously redirecting attention away from pain can help you feel better. (It is important to mention that with distraction/ attention refocusing you are not ignoring your pain or other symptoms. Instead, you are
choosing
not to dwell on them.)

Sometimes it may be difficult to put pain or other anxious thoughts out of your mind. When you try to suppress any thought, you may end up thinking more about it. For example, try not thinking about a tiger charging at you. Whatever you do, don’t let the thought of a tiger enter your mind. You’ll probably find it nearly impossible not to think about the tiger.

Although you can’t easily stop thinking about something, you can distract yourself and redirect your attention elsewhere. For example, think about the charging tiger again. Now stand up suddenly, slam your hand on the table,
and shout
“Stop!”
What happened to the tiger? Gone—at least for the moment.

Distraction is especially good for short activities or times when symptoms may be anticipated. For example, if you know climbing stairs will cause discomfort or that falling asleep at night is difficult, you might try one of the following distraction techniques:

• Make plans for exactly what you will do after the unpleasant activity passes. For example, if climbing stairs is uncomfortable or painful, think about what you will do once you get to the top. If you have trouble falling asleep, try making plans for some future event, being as detailed as possible.
  

• Think of a person’s name, a bird, a brand of car, or whatever, for every letter of the alphabet. If you get stuck on one letter, go on to the next. (This is a good distraction technique for pain as well as for sleep problems.)
  

• Challenge yourself to count backward from 100 by threes (100, 97, 94 …).
  

• To get through unpleasant daily chores such as sweeping, mopping, or vacuuming, imagine your floor as a map of a country or continent. Try naming all the states, provinces, or countries, moving east to west or north to south as you work. If geography does not appeal to you, imagine your favorite store and where each department is located.
  

• Try to remember words to favorite songs or the events in an old story.
  

• Try the
  “Stop!”
  technique. If you find yourself worrying or entrapped in endlessly repeating negative thoughts, stand up suddenly, slap your hand on the table or your thigh, and shout
  “Stop!”
  With practice, you won’t have to shout out loud. Just whispering
  “Stop!”
  or tightening your vocal cords and moving your tongue as if saying
  “Stop!”
  will often work. Some people imagine a large stop sign. Others put a rubber band on their wrist and snap it hard to break the chain of negative thought. Or just pinch yourself. Do anything that redirects your attention.
  

• Redirect your attention to a pleasurable experience:
  

There are, of course, many variations to these examples, all of which can help you refocus attention away from your problem.

So far we have discussed short-term refocusing strategies that involve using only the mind for distraction, but long-term projects also work well. In these cases, the mind is focused not internally but externally on some type of activity. Find an activity that interests you and distracts you from the pain or other symptoms you might have. It can be almost anything, from gardening to cooking to reading or going to a movie, even doing volunteer work. One of the marks of a successful self-manager is that he or she has a variety of interests and always seems to be involved in something.

We all talk to ourselves all the time. For example, when waking up in the morning, we might think, “I really don’t want to get out of bed. I’m tired and don’t want to go to work today.” Or at the end of an enjoyable evening, we think, “Gee, that was fun. I should get out more often.” What we think or say to ourselves is our “self-talk.” The way we talk to ourselves is influenced by how we think about ourselves. Our self-image can be positive or negative, and so is our self-talk. Self-talk can be an important self-management tool when it’s based on positive thinking or a weapon that hurts or defeats us when it’s habitually negative.

Negative self-statements usually begin with something like, “I just can’t do …,” “If only I could …,” “If only I didn’t …,” or “I just don’t have the energy …” This type of negative thinking represents the doubts and fears you have about yourself in general. This translates into doubts and fears about your abilities to deal with your pain condition and its symptoms.

Negative self-talk has no place in pain management. It damages your self-esteem, attitude, and mood. It makes your pain worse by opening the pain gate and makes your other symptoms worse as well. What you say to yourself plays a major role in determining your success or failure in becoming a good self-manager. Negative thinking limits your abilities and actions. If you tell yourself “I’m not very smart” or “I can’t” all the time, you probably won’t try to learn new skills because positive change just doesn’t fit with how you think about yourself. Soon you become a prisoner of your own negative beliefs.

Fortunately, self-talk is not fixed in our biological makeup, and therefore it is often within our control. You can learn new, healthier ways to think about yourself so your self-talk can work for you instead of against you. By changing the negative, self-defeating statements to more positive, realistic ones, you can manage symptoms more effectively. This change, like any habit, requires practice and includes the following steps:

1.   
Listen carefully to what you say about yourself, both out loud and silently
. If you find yourself feeling anxious, depressed, or angry, try to identify some of the thoughts you were having just before these feelings started. Then write down all the negative self-talk statements. Pay special attention to the things you say during times that are particularly difficult for you. For example, what do you say to yourself when getting up in the morning with pain, while doing those exercises you don’t really like, or when you are feeling blue? Challenge these negative thoughts by identifying what is really true or not true about the statement. For example, are you exaggerating the situation, generalizing, worrying too much, or assuming the worst? Are you thinking in terms of black and white? Could there be gray? Maybe you are making an unrealistic or unfair comparison, assuming too much responsibility, taking something too personally, or expecting perfection. Are you making assumptions about what other people
think about you? What do you know for a fact? When you look at the evidence in this way, you will be better able to change these negative thoughts and statements.

2.   
Next, work on changing each negative statement to a more positive one
. For example, you might find yourself saying negative statements such as:

3.   
Write down and rehearse these positive statements, mentally or with another person
. This conscious repetition of the positive self-talk will help you replace those old, habitual negative statements.

4.   
Practice new statements in real situations
. This practice, along with time and patience, can help the new patterns of thinking become automatic.

5.   
Rehearse success
. When you aren’t happy with the way you handled a particular situation, try this exercise:

Remember that mistakes aren’t failures; they’re good opportunities to learn. Mistakes give you the chance to rehearse other ways of handling things. This is great practice for future crises.

At first, you may find it hard to change negative statements into more positive ones. A shortcut is to use either a thought stopper or a positive affirmation. A thought stopper can be anything that is meaningful to you—for example, a puppy, a polar bear, or a beautiful sunrise. When you have a negative thought, replace it with your thought stopper. We know it sounds silly, but try it.

A positive affirmation is a positive phrase that you can use over and over. For example, “I am getting better every day” or “I can do this” or “I’m a good person.” Use this phrase to replace negative thoughts.

You may think that “imagination” is all in your mind. But the thoughts, words, and images that flow from your imagination can have very real effects on your body. Your body often cannot distinguish whether you are imagining something or if it is really happening. Perhaps you’ve had a racing heartbeat, rapid breathing, or tension in your neck muscles while watching a movie thriller. These sensations were all produced by images and sounds on a film. During a dream, your body may have responded with fear, joy, anger, or sadness—all triggered by your imagination. If you close your eyes and vividly imagine yourself by a still, quiet pool or relaxing on a warm beach, your body responds to some degree as though you were actually there.

Guided imagery and visualization allow you to use your imagination to relieve symptoms. These techniques will help you focus on healing images and suggestions.

This tool is like a guided daydream. Guided imagery allows you to refocus your mind away from your pain and other symptoms by transporting you to another time and place. It has the added benefit of helping you achieve deep relaxation by picturing yourself in a peaceful environment.

In guided imagery, the images are suggested to you by a script like the one included in this book on
page 90
. With guided imagery, you focus your mind on a particular image. This
usually begins with your sense of sight, focusing on something visual. Adding other senses—smells, tastes, and sounds—makes the guided imagery even more vivid and powerful.

Some people are highly visual and easily see images with their “mind’s eye.” But if your images aren’t as vivid as scenes from a great movie, don’t worry; it’s normal for the intensity of imagery to vary. The important thing is to focus on as much detail as possible and to strengthen the images by using all your senses. Adding real background music can also increase the impact of guided imagery.

With guided imagery, you are always completely in control. You’re the movie director. You can project whatever thought or feeling you want onto your mental screen. If you don’t like a particular image, thought, or feeling, you can redirect your mind to something more comfortable. You can use other images to get rid of unpleasant thoughts; for example, you might put them on a raft and watch them float away, sweep them away with a large broom, or erase them with a giant eraser. Or you can just open your eyes and stop the exercise.

The guided imagery scripts presented on
pages 90
and
91
can help take you on this mental stroll. Here are some ways to use these scripts:

• Read the script several times until it is familiar. Then sit or lie down in a quiet place and try to reconstruct the scene in your mind. The script should take 15 to 20 minutes to complete.
  

• Have a family member or friend slowly read the script to you, pausing for about 10 seconds wherever there is a series of periods (…).
  

• Make a recording of the script and play it to yourself whenever convenient.
  

• Use a prerecorded tape, CD, or digital audio file that has a similar guided imagery script (see the “Other Resources” section at the end of this chapter).
  

Visualization allows you to create your own images, which is different from guided imagery, where the images are suggested to you. Visualization is another way to use your imagination and create a picture of yourself in any way you want, doing the things you want to do.

All of us use a form of visualization every day—when we dream, worry, read a book, or listen to a story. In all these activities the mind creates images for us to see. We also use visualization intentionally when making plans for the day, considering the possible outcomes of a decision we have to make, or rehearsing for an event or activity.

One way to use visualization to manage symptoms is to remember pleasant scenes from your past. Try to remember every detail of a special holiday or party that made you happy. Who was there? What happened? What did you do or talk about? Or you can remember a vacation or some other memorable and pleasant event.

Visualization also can be used to plan the details of some future event or to fill in the details of a fantasy. For example, how would you spend a million dollars? What would be your ideal romantic encounter? What would your ideal home or garden look like? Where would you go and what would you do on your dream vacation?

Another form of visualization involves thinking of symbols that represent the discomfort or pain you feel. For example, a painful joint might be red, or a tight chest might have a constricting band around it. After forming these images, you then change them in your mind. The red color might fade until there is no more color, or the constricting band will stretch and stretch until it falls off. These new images transform the way you think of the pain or discomfort.

Visualization helps build confidence and skill and therefore is a useful technique to help you set and accomplish personal goals (see
Chapter 2
). After you write your weekly action plan, take a few minutes to imagine yourself taking a walk, doing your exercises, or making a healthy meal. Visualization is a way to rehearse the steps you need to take in order to achieve your goal successfully.

You have the ability to create special imagery to help ease (though not cure) your specific symptoms or illnesses. Use any image that is strong and vivid for you—this often involves using all your senses to create the image—and one that is meaningful to you. The image does not have to be accurate for it to work. Just use your imagination and trust yourself. Here are examples of images that some people have found useful to help them deal with various situations:

For Tension and Stress

A tight, twisted rope slowly untwists.

Hard wax softens and melts.

Tension swirls out of your body and down the drain.

For Pain

You grasp the TV remote control and slowly turn down the pain volume until you can barely hear it; then it disappears entirely.

A cool, calm river flowing through your entire body washes away the pain.

A radiant white light finds the areas of pain and tension in your body and dissolves them. As the light leaves your body, you feel warm and relaxed in its glow.

All of your pain is placed in a large, strong metal box that is closed, sealed tightly, and locked with a huge padlock. The box is placed on the deck of a ship that is heading out to sea.

For Depression

Your troubles and feelings of sadness are attached to big, colorful helium balloons and float off into a clear blue sky.

A strong, warm sun breaks through dark clouds.

You feel a sense of detachment and lightness, enabling you to float easily through your day.

For Healing of Cuts and Injuries

Plaster covers over a crack in a wall.

Cells and fibers stick together with very strong glue.

A shoe is laced up tight.

Jigsaw puzzle pieces come together.

For Arteries and Heart Disease

A miniature Roto-Rooter truck speeds through your arteries and cleans out the clogged pipes.

Water flows freely through a wide, open river.

A crew in a small boat rows in sync, easily and efficiently pulling the slender boat across the smooth surface of the water.

For a Weakened Immune System

Sluggish, sleepy white blood cells awaken, put on protective armor, and enter the fight against the virus.

White blood cells rapidly multiply like millions of seeds bursting from a single ripe seedpod.

For an Overactive Immune System (arthritis, psoriasis, etc.)

Overly alert immune cells in the fire station are reassured that the allergens have triggered a false alarm, and they go back to playing a game of poker.

The civil war ends with the warring sides agreeing not to attack their fellow citizens.

Use any of these images, or make up your own. Remember, the best ones are vivid and have meaning to you. Use the power of your personal imagination for health and healing.